Effectiveness of the McKenzie Method for Treating Low Back Pain. A Systematic Review

The McKenzie Method is a classification based system and treatment programme for patients suffering from low back pain (LBP). It was developed in 1981 by Robin McKenzie a PT from New Zealand. This type of classification-based system of diagnosing and treating LBP has been around for some time now and, where as before there was evidence suggesting this was the way to get best results for our patients, now there is a raft of evidence which contradicts this belief.

The McKenzie Method classifies patients into 4 groups: Derangement, Dysfunction, Postural Syndrome and Other. These groups then direct the appropriate treatment required.  To find out more about the classifications, what they mean and the relevant treatments please read the Physiopedia page.

A concern with research involving the McKenzie Method, and other classification systems, is the use of underpowered and poor methodological studies as evidence demonstrating their effectiveness (an example).

There has been a Systematic Review (SR) & Meta-Analysis completed before investigating the evidence for suggesting the McKenzie Method is effective at what it sets out to do. In essence it concluded there was a lack of evidence supporting its use and more studies were required. This was over a decade ago and since then more research has been published and, as Tam et al suggest, there were issues with the search criteria used for this SR.

This is the rationale for Lam et al use for performing this updated and stronger SR. They have included the research published in the past decade as well as correcting the mistakes their colleague included in their initial SR.

In terms of the findings from the SR and clinical implications. If we only consider research of an appropriate quality then we can say:

For acute pain:

  1. The McKenzie Method is not clinically superior to all interventions in treating acute LBP but is more effective at reducing pain intensity when compared to manual therapy and exercise combined.

For chronic pain:

  1. The McKenzie Method was more effective at reducing pain and disability than “other” interventions,
  2. McKenzie Method was more effective at reducing disability but not pain when compared to exercise alone,
  3. McKenzie Method was not more effective than a combined exercise, manual therapy and education intervention.

As always take these findings with a pinch of salt. The effects of the McKenzie Method could be as a result of the fact large groups of patients may not fall into their subgroups and would have benefited from any exercise anyway.  The McKenzie Method is a mechanical-based system and does not account for psychological aspects of pain or alternative theories of pain. It lumps you into a category, disregards psychological aspects or more nuanced aspects of treatments. Still this doesn’t mean McKenzie isn’t a viable option for treatment. Just bare this in mind. Other treatments and assessment tools / strategies have proven as or more effective.

Oh and don’t forget about the Regression to the Mean effects.